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Acne — those rashy, pimply bumps that tend to flare up just when you have a big meeting or wedding on your calendar — can appear on your face (of course), hairline, neck, breasts, and, yes, your butt. Even if you haven't had a killer zit since prom night, you may get some doozies while you're pregnant.

What causes pregnancy acne?

Two things conspire to cause breakouts, which tend to hit sometime around week 6 of pregnancy: hormone surges, of course (in this case, progesterone, which causes your glands to increase acne-causing secretions of oil, called sebum) can clog up pores and cause bacteria to build up, leading to breakouts. And your body is also retaining more fluids, which contain toxins that can lead to zits. Yikes!

What you can do about it

Clean up. Your best offense is a good defense: Prevent flare-ups and scars by taking good care of your skin during pregnancy. Clean your face gently with a mild, soap-free cleanser twice a day, once in the morning and once at night. Make sure to wash and rinse thoroughly, especially around your hairline and jaw, where pores tend to get clogged. Wash your hair on a regular basis, especially if it’s oily. And keep your pillowcases, towels and any hats you wear regularly clean as well.

But don’t be tempted to scrub zits away. Over-washing or getting overaggressive with scrubs doesn’t work — not only because you probably have extra sensitive skin during pregnancy, but because over-washing strips your skin of its natural moisture, which in turn causes your oil glands to go into overdrive trying to replenish what you’ve removed, making it more prone to breakouts. And don't squeeze or pick at pimples either, as tempted as you might be. As your mother always warned you (and this time she’s right), these tactics will only make zits last longer and can cause scars.

Moisturize. While it might seem counter-intuitive, using an oil-free moisturizer can actually help minimize the irritation – sometimes skin that’s overly-dried by harsh acne soaps is more prone to breakouts.

Read before you buy. Look for skin care, makeup, and even hair care products that are oil-free and are labeled non-comedogenic or non-acnegenic (formulated not to cause acne). Oil-free moisturizers and makeup are a good idea as well.

Be sun-savvy. Many medicines used to treat acne (including those that are safe to use during pregnancy) can make you more prone to sunburn. And while the sun may help dry out your acne lesions, that help doesn’t come without a price: Too much sun not only increases your risk of skin cancer and causes early aging of the skin, it can also bring on other blotches during pregnancy. Whenever you’re going to be outside, use sunscreen of at least SPF 15 — and make that an oil-free one (see below). Better still, have it made in the shade (a parasol can be quite a fashion statement).

Get A-listed. Increase your dietary intake of vitamin A – which helps keep skin healthy – through foods such as milk, fish, eggs, and carrots. Steer clear of extra vitamin A supplements since an excess of A has been shown to cause birth defects, and concentrate instead on getting ample A through your (healthy!) diet.

Eat smart. Speaking of diet, cutting out (or just cutting back on) sugar and refined grains can do wonders for your skin (opt for whole grains instead). Also, unhealthy fats (aka the saturated fats found in fried foods and many baked goods) can aggravate acne, so replace these eats with skin-boosting healthy fats like avocado, salmon, walnuts, and almonds. More skin friendly foods: colorful fresh fruits and vegetables and, believe it or not, small amounts of dark chocolate (the darker the better). Just eat in moderation, Mama — chocolate does contain caffeine.

Drink up. Drinking plenty of water helps flush out your skin, keeping it moist and clearer.

Talk to your practitioner. He or she can recommend what topical acne treatments are okay to use — some will allow benzoyl peroxide or azelaic acid (an antibacterial cream available only by prescription). You may also be able to use creams that contain erythromycin or other antibiotics — as long as they’re cleared by your practitioner. Glycolic acid and exfoliating scrubs are also probably safe to use – but don’t use any medication, topical or oral, unless it’s been prescribed or cleared by a practitioner who knows you're pregnant (or trying to conceive).

What solutions are off-limits

Serious breakouts in adults are sometimes tackled with such strong-arm products as Accutane, Retin-A, and other topical retinoids (tretinoin, isotretinoin, tazarotene, and adapalene) — which are all completely off-limits until after you deliver and wean, since they can be absorbed through the skin into your breast milk and your — and your baby’s — bloodstream. More definite no-nos: tetracycline and oral isotretinoin, both of which can cause birth defects. In fact, it’s best to avoid virtually all oral acne medication during pregnancy (though oral erythromycin may be prescribed safely for severe acne).

Two common topical medications, beta-hydroxy acid (BHA) and salicylic acid, have not been studied in pregnant women and may be absorbed through the skin. There is a huge range of products that contain these chemicals, including many expensive skin creams as well as drugstore options like some Neutrogena, Oil of Olay, and Avon products — even those ever-popular Stridex pads. The key to playing it safe is to read the label and steer clear if BHA or salicylic acid is on the ingredient list, at least until after you deliver and wean. If you used products containing beta-hydroxy or salicylic acid before you knew you were pregnant, don’t worry. Just stop now.

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